Predictors of improvement in LV ejection fraction post PVC ablation

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Abstract Introduction Premature ventricular contraction (PVC) is a frequently encountered finding in routine ECGs, that in certain individuals may be followed by reduction in ejection fraction (EF). This may be improved or even reversed with a medical or interventional reduction of ectopic burden. Objective The primary objective of this study is to assess the potential effectiveness of cardiac ablation in suppressing PVC and subsequently enhancing the EF. Further we aim to establish predictive factors of the success of the intervention. Methods In a retrospective data analysis at a single medical centre, we examined records of 116 patients who underwent ectopic ablation, with 10 patients having more than 1 ablation. Demographic information, heart-related conditions along with the presence of a scar on MRI, was collected. The study also recorded pre- and post-procedure PVC burden and EF measurements. Results Demographics and procedural details are in table 1. It was found that patients participating in this study were predominantly male (66.4%), on average 60.1 (± 13.6) years old, overweight (BMI 29.8 ± 5.4) with no additional heart disease (56%) and no scarring on MRI (55%).The PVC burden before ablation (27.9 ± 12.7) significantly reduced to 8.0 ± 11.2 post-ablation (p < 0.005), marking an average relative reduction of 68.1% (± 44.1%). Successful interventions, defined by a reduction exceeding 50%, were observed in 79% of patients. The EF increased from 39.6 ± 8.9 to 47.5 ± 10.7 post-ablation (p < 0.005), corresponding to an average increase by 8.4 ± 8.5. Notably amongst the patients who had a successful ablation, 36% of patients achieved normalized EF (>55%) and 42% showed an improvement of at least 5%. A strong correlation emerged between the relative change in PVC and the ejection fraction measured after ablation, with an increase by 0.10 for every percent reduction (p < 0.00). The relative increase in the EF% was significantly higher in patients where the PVC burden was reduced by at least 50% (figure 1). Linear fixed effect modelling explored the influence of patient characteristics on the model. Patients with higher BMI had a lower EF after ablation with same relative reduction in PVC (p < 0.03). Similarly, a scar on MRI and associated heart condition was associated with reduced improvement in ejection fraction (p < 0.02). Also, for every increase in age patients had a reduction of 0.2 EF after ablation (p < 0.01). Right heart PVC’s were ablated more successfully, and had higher EF post ablation (p < 0.01). Conclusion In conclusion, reduction in PVC burden increases the EF after treatment. Increasing BMI, age and presence of associated heart disease can negatively impacted LVEF post ablation. Further research could improve the model that predicts improvement in LV function post successful PVC ablation.Figure 1Table 1